Thursday, May 03, 2012

So, I'm Pretty Sure This Guy Gets Some Sort Of Triple Crown Of Pharmacy Customer Award. A Quick Lesson For Those Of You Not In The Pharmacy Business.

Picking up some clonazepam, a sedative much like Valium he was. After asking if it was too soon to fill (which means he has been told before that a prescription he wanted couldn't be filled yet)

Then asked if he had ever had his Adderall, a brand of amphetamine, filled here. (Because he can't keep track of the multiple pharmacies he uses for his meds)

He had. Next question, "It wasn't billed on my insurance was it?" This question will seem the most bizarre to those not in the profession. "Why on earth would you not want to use insurance?" you're asking yourself. But when you're using multiple pharmacies to pick up the same med you see, the second one you try will generate a "refill too soon" reject when it files your claim. The way around this is to use your card at one place and pay out of pocket everywhere else.

There are the questions we hear all day long. Rarely though, from the same customer. In the same transaction. Guess the moon was lined up just right.

And to top it off, he had one more query.

"Yeah....um......what happens if you give Viagra to a woman?"

His girlfriend was there next to him. And she looked appropriately horrified.

11 comments:

Anonymous
said...

The moon.

I never believed it before I left school. Now I ponder the Farmer's Almanac (Pharmer's almanac? He!) when picking out a new calender.

Also, the rule of 3: Patients die in 3's. The hardware breaks down in 3's (printer, coffeemaker, main electrical panel to store, whatever). Now, asking all 3 top drug-seeker questions in the same transaction - that takes the prize. You win. Extra tequila in your margarita for Cinco de Mayo.

I don't think that last question is objectively stupid at all. It's the sort of question an inquisitive person might come up with just out of the blue.

That being said, it's obvious that what we have here is not a person interested in the effects of a drug when used other than for its most commonly known purpose, but a guy wondering if he has suddenly discovered the effective version of Spanish Fly.

Just yesterday I read an article about clonazepam being the most abused prescription drug. Having had a grand mal seizure discontinuing it as directed after taking it for just several months as prescribed I find it just astounding that people are taking these drugs for recreation. They can really fuck you up.

P-docs are entirely too quick to prescribe drugs, to prescribe drugs for the effect of the one prescribed, and to keep prescribing them. This classic upper/downer routine is something psychiatrists should be scrupulously avoiding.

I'm curious to hear what pharmacists have been trained to do, if anything, when faced with a drug abusing customer. And if some pharmacists have caught on to the doctors behind some of the most egregious prescribing habits and were in a position to do something about it.

"It wasn't billed on my insurance was it?" This is amusing on two levels for those all too familiar with how this works. The first, as DrugMonkey mentioned, is that abusers will pay cash at one pharmacy even though they have coverage. The second is that usually people who ask this question do not have "insurance." "Insurance" is a voluntary contractural business relationship where a person pays a premium to cover unforeseen expenses. "Medicaid" is a system where taxpayers are coerced into paying the expenses of recipients. Most of the people who ask "It wasn't billed on my insurance was it?" have Medicaid.

Which, is one of the reasons I'm wondering if pharmacists have any role in reporting abuses. I'm guessing that stores that have pharmacists stocking shelves and answering phones are more likely to discourage scrutiny on the part of pharmacists, unless the stores can be held liable for sales to Mr. Triple Crown.

Which is not to suggest that I think pharmacists should be required to police prescriptions. Your education is not being put to good enough use as it is if you're conscripted to fill retail functions.

Methinks the doctors should consult with a pharmacist before writing a scrip, and consult again when combining drugs and/or changing doses and/or discontinuing a drug or drugs. And pay well for it, because it would save money in the long run.

Hmmmm. There used to be HIPAA regs we pharmacists had to follow scrupulously, enacted after too many businesses (i.e. drug manufacturers, insurance companies, etc.) were involved in 'purchasing' our prescription records.

But, hey, about that scheme... I wonder if you have ever heard tell before of this strange and totally unheard of idea...it used to be when we at the hospital filled ER scripts (especially the benzos because we didn't fill CIIs for ER patients), those 'patients' would turn around and sell them for cash, so they could pay with big bills for that second (and, third, and fourth prescription). Who woulda guessed? When a person gets something for free, that they wouldn't take advantage of the 'system'?

Never fails - anytime I had to work over a weekend during a full moon, the pharmacist & I would have the strangest customer interactions, leaving us either shaking our heads or picking our jaws up off the floor from observing sheer stupidity at its finest. I do recall myself participating in some heavy drinking after those shifts :)

Another of my favorites: "do you work here?" "no sir, I just like to wear the lab coat and a name tag followed by the initials CPhT, and stand behind this pharmacy counter for funsies". That one tends to only come up on the full moon as well for some reason.

This is amusing, as it could just as well be an account of an experience I had - as the patient requesting the Rx's (and I'm usually a care provider rather than patient as a CRNA). I was on clonazepam (Klonopin) and amphetamine salt combo (Adderall) concomitantly for several years. I remember once while an undergrad going to a national chain pharmacy where I had an Rx discount card to request my Klonopin be refilled, then inquiring as to whether I had filled my Adderall through that chain (ie that pharmacy) due to having recently switched from a regional chain to the national one. I had also recently dropped my PPO Rx coverage and (unaware of the 'red flag' it would cause at the time) inquired as to whether they put it on my insurance (the old PPO). Of course now I am older and wiser (roll eyes).